Search form

Analysis

Topics

The value-based primary care model focuses on relationships with care teams that include physicians, health coaches, behavioral health specialists, nurses, and a clinical team manager working together to treat the whole patient.

Boston-based Iora Health, the care team-oriented Medicare Advantage primary care provider, this month secured$100 million in funding to support its growth and technology platform.

Rushika Fernandopulle, MD, co-founder and CEO of Iora Health, spoke with HealthLeaders Media about the provider's plans for expansion, and the care model that he believes can transform healthcare delivery.

The following is an edited transcript.

HLM: You say your model is unique. How so?

Fernandopulle: We obviously think we are unique, although increasingly the rest of the world is figuring out that we're going in the right direction. We're saying that if we want to change healthcare, then we have to change how actual people get actual care, not just nibbling around the edges. A good place to start is primary care.

The primary care model, which is take-a-number reactive and receive-a-service transactional, isn’t what we need. What we need is a radically different model that is relational. And that is what we are doing.

The worst thing to do is try to do both at the same time, which is what a lot of providers are trying to do. Try to do fee-for-service with the same processes as a version of what we are doing. Our big advantage is focus. This is a new model of care and it's all we're doing. There is a small number of us who are de novo start-ups who want to change healthcare with a different business model.

HLM: Why the focus on Medicare Advantage?

Fernandopulle: Because our model is a relationship-care model we have to get paid differently. That is the whole point. By and large we work with Medicare Advantage plans and serve their members so we can contract in a value-based way, not a volume-based way.

HLM: Does the Iora model cherry pick its patients?

Fernandopulle: We're not cherry pickers. Whatever the opposite of cherry picker is, that's what we're doing. We go to places that have older, sicker people, and that's correlates with lower income, because we think we can help them.

So, we go to Phoenix, where we have a number of practices. We're not in Scottsdale, where the rich people live. We're in places like Indian School, where lower income, tend to be sicker, older people live. The model works great, maybe even better for people the sicker they are.

HLM: Could the Iora model work with traditional Medicare?

Fernandopulle: We have to get paid differently to make these models work. We are limited from working with traditional Medicare at the moment, because of the current payment model. Hopefully, some day that will change.

HLM: What metrics do you use to gauge success?

Fernandopulle: We look at the quintuple aim. We look at patient experience, because we are a service business and we need to get patients to vote with their feet.

No. 2 is improving health outcomes. We are a healthcare delivery company.

No. 3 is we need to impact total cost of care. So, people getting the care they don't want or need is not just harmful but wasteful. We see big drops in total spending by keeping people away from stuff they don’t need.

No. 4 is joy in practice. We need to do it in a way where our teams, and in particular our doctors, are happier.

And No. 5, we need to do it in an economically sustainable way. We actually have practices that don't lose money. We do well in all five of those and we can do better in all five of those. What we're doing, and what we are using our funds for, is to continue to build out our infrastructure and the way we do things to be able to perform better on those five metrics.

Our big advantage is we're trying to fix the right things. We're not trying to generate volume, or use higher codes or play coding games or any of that stuff. We're trying to improve people's health and build systems to help us do that. We are fighting the right fight.

HLM: What is Iora's relationship with its physicians?

Fernandopulle: They all work for us. We are building practices. We install the IT platform, and the software for the Iora-affiliated physician groups. This is not a loose network. We feel like we need to build a new model and have it be consistent. It means we can figure out the right way to do things and we can actually do it.

HLM: What will you do with this $100 million investment?

Fernandopulle: Several things. One is we will continue to improve our infrastructure on the people side and the technology side. We made the decision early on that we have to build a different technology platform to do this kind of care.

The existing electronic health records are, not surprisingly, built to power the old system to make the bills higher. We don't care. We don't think that adds value. What we need is a system that will help us engage patients, improve health. And to do that we have to build a different technology platform.

No. 2 is we will continue to invest in growth. We are doubling in size each year. We are opening a number of new sites. We will continue to grow and increase our impact across the country.

HLM: Where do you see Iora in five years?

Fernandopulle: Our mission is to transform healthcare. It's not just about providing care for the people who happen to be our patients. We need to kick the industry in the behind and say that the way we are doing it now doesn't work and we need to change. We need to raise the bar.

We hope we will be bigger and have more patients, but we also hope to have an impact on the rest of the industry and get them to move in this direction.

HLM: Will the investors influence your business decisions?

Fernandopulle: No! We run the company. They are investing because they think what we are doing is the right thing to do and beneficial. We are obviously open to getting people's input, but they don’t get to tell us what to do.

HLM: What was the elevator sales pitch to investors?

Fernandopulle: Simply that this is the biggest business and moral imperative in the country, and maybe the world; the gap between the $3.3 trillion we are spending on healthcare, and what we are getting in return. If you want to address that, this is a huge opportunity.

Let's stop dancing around the edges, and provide actual people with actual care, and primary care is a good lever to do that.

“What we need is a radically different model that is relational. And that is what we are doing.”